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Dec 02, 2023

Journal Watch: Platelet Rich Plasma Injections Outperform Steoids and Prolotherapy for Carpal Tunnel Syndrome in New Network Meta-analysis

Carpal tunnel syndrome is common and presents as numbness, pain and sensory abnormalities in the wrist and hand. Treatments are typically divided into conservative treatments and surgery. Surgery can be highly effective, but in mild to moderate carpal tunnel syndrome conservative treatments can be effective and include injections, splinting, and hand therapy.

Corticosteroid injections are common in mild to moderate carpal tunnel syndrome (2, 10), however the therapeutic effects is limited and has not shown long-term benefits (Catapano et al.).

Recently, clinical trials have shown platelet rich plasma, or PRP Injections, can have a therapeutic effect on carpal tunnel syndrome. PRP is a blood-derived product composed of concentrated platelets, and basic science studies have shown that nerve cells (Schwann cells) proliferate and migrate to enhance nerve tissue repair (Malahias et al.; Shen et al.; Trull-Ahuir et al.). Prolotherapy using dextrose (D5W) has also shown clinical benefit for carpal tunnel syndrome (Shen et al.; Wu et al.; Wu et al.).

Gao et al. (2023) recently performed a systematic review and network meta-analysis to explore the data on these injections for carpal tunnel syndrome. This study analyzed 12 randomized controlled studies (RCT) comparing the results of corticosteroid injections, PRP and prolotherapy injections. No adverse events were reported in the 12 studies, and PRP was the best at relieving symptoms, improving function and alleviating pain.

Prior network meta-analysis have examined this question with different conclusions, but these examined fewer studies (Lin et al.).

Take Home

PRP contains many growth factors that can reduce inflammation and enhance nerve tissue repair by promoting nerve cell (Schwann cell) proliferation (Hashim et al.; Sanchez et al.; Hirata et al.; Malahias et al.). In this systematic review and network meta-analysis, PRP showed greater benefit for carpal tunnel syndrome when compared to corticosteroid injections and prolotherapy.


Catapano M, Catapano J, Borschel G, Alavinia SM, Robinson LR, Mittal N. Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2020 May;101(5):897-906.

Gao N, Yan L, Ai F, Kang J, Wang L, Weng Y. Comparison of the Short-Term Clinical Effectiveness of 5% Dextrose Water, Platelet-rich Plasma and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2023 May;104(5):799-811.

Hashim, N.A., Fathy, H.A., Esawy, M.M. et al. Comparison of efficiency between platelet rich plasma and corticosteroid injection therapies in patients with Carpal tunnel syndrome: a prospective randomized controlled study.Egypt J Neurol Psychiatry Neurosurg 56, 59 (2020).

Hirata H, Nagakura T, Tsujii M, Morita A, Fujisawa K, Uchida A. The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome. J Pathol.2004 Dec;204(5):605-12.

Lin CP, Chang KV, Huang YK, Wu WT, Özçakar L. Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Pharmaceuticals (Basel). 2020 Mar 18;13(3):49.

Malahias MA, Chytas D, Mavrogenis AF, Nikolaou VS, Johnson EO, Babis GC. Platelet-rich plasma injections for carpal tunnel syndrome: a systematic and comprehensive review. Eur J Orthop Surg Traumatol. 2019 Jan;29(1):1-8.

Malahias MA, Johnson EO, Babis GC, Nikolaou VS. Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome. Neural Regen Res. 2015 Nov;10(11):1856-9.

Sánchez M, Anitua E, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212.

Shen YP, Li TY, Chou YC, Ho TY, Ke MJ, Chen LC, Wu YT. Comparison of perineural platelet-rich plasma and dextrose injections for moderate
carpal tunnel syndrome: A prospective randomized, single-blind, head-to-head comparative trial. J Tissue Eng Regen Med. 2019 Nov;13(11):2009-2017.

Trull-Ahuir C, Sala D, Chismol-Abad J, Vila-Caballer M, Lisón JF. Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial. Sci Rep. 2020 Feb 7;10(1):2085.

Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen LC. Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial. Mayo Clin Proc. 2017 Aug;92(8):1179-1189.

Wu YT, Ke MJ, Ho TY, Li TY, Shen YP, Chen LC. Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol. 2018 Oct;84(4):601-610.

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